Mixed ionic electronic conductors for improved charge transport in electrotherapeutic devices

ABSTRACT

This invention addresses the need for efficient dry skin electrodes. Robust, flexible Mixed Ionic Electronic Conductor (MIEC) electrodes were prepared by an aqueous solution route resulting in electrically conductive networks of carbon nanotubes (CNTs) and ionically conductive elastic matrix. The flexible electrode was characterized in terms of conductivity, ionic charge transfer resistance, and water uptake. The flexible electrode maintained low resistance even after multiple cycles of 50% extension and contraction.

RELATED APPLICATIONS

This application is a national stage filing and claims the prioritybenefit of PCT/US18/26981 filed 10 Apr. 2018 and also claims priority toU.S. Provisional Patent Application No. 62/483,942, filed 10 Apr. 2017.The disclosures of these applications are incorporated by reference.

INTRODUCTION

The goal that led to the invention was to develop a conductive,elastomeric electrode for use in electrotherapeutic medicine. Theelectrode can be used in neuromuscular electrical stimulation (NMES) andiontophoretic drug delivery.

Conventional electrodes for electrotherapeutic devices use a metal orinorganic conductive material (e.g., TiN, Ir—IrO₂, Pt) plus a couplinglayer (e.g., electrolyte). An electrode is placed where a redox reactiontakes place between the device and the tissue of patient. Thus, it mustconduct both electrons and ions. The reactions can be faradaic orcapacitive, involving the charging and discharging of theelectrode-electrolyte double layer. Capacitive charge injection is moredesirable than faradaic charge injection because no chemical species arecreated or consumed during a stimulation pulse. Most conventionalelectrodes are faradaic or pseudo-capacitive, which can lead toperformance changes over time. In addition, under the high rate ofcharge injection and high current density conditions of a neuromuscularstimulation pulse, access to all the accessible charges is limited bythe interfacial resistance and low surface area at the electrode. Fordurable electrodes, a low resistance that does not vary with time orhumidity is required.

The current state of organic electrode coatings has been reviewed byAregueta-Robles et al. in “Organic electrode coatings fornext-generation neural interfaces,” Frontiers in Neuroengineering, vol.7, pp. 1-18 (May 2014). The authors reported that blending hydrogelswith conductive components such as CNTs may provide desired electricalcharacteristics with reduced stiffness. Wallace et al. in US PublishedPatent Application No. 2010/0173228 discuss nanostructured compositeswhich may contain CNTs and biomolecules such as hyaluronic acid.

The present invention provides novel electrode materials that willadvance electrotherapeutic medicine.

SUMMARY OF THE INVENTION

An important aspect of this invention is that the electrical and ionicconductors are embedded in the matrix in such a way that the electricaland ionic elements achieve percolation, i.e., a continuousinterconnected network, at lower loading than would be achieved bysimple random mixing. This allows the electrical performance to beachieved while retaining the necessary mechanical properties.

In a first aspect, the invention provides an electrode, comprising:

coalesced elastomer particles, CNTs, and a glycosaminoglycan; whereinthe CNTs and glycosaminoglycan are disposed on the exterior of thecoalesced elastomer particles. This solid structure may be observed byoptical or electron microscopy and well-known techniques for analyzingcomposition such as Auger spectroscopy. The coalescence of latexparticles occurs naturally as the suspension medium is removed. Theindividual components may be additionally identified by well-knowntechniques from the dispersed or partially dissolved electrode such aschromatography and spectroscopy.

In a second aspect, the invention provides an electrode, comprising:

elastomer, CNTs, and a glycosaminoglycan; and characterizable by: aconductivity of at least 1000 mS/cm that changes by less than 10% after5 strain cycles of extending the material by 50% and allowing thematerial to contract. While the first aspect of the invention is basedon chemical knowledge; the second aspect is directly tied to superiorand surprising observed results; and thus the second aspect is anecessary and important alternative way to define the invention. In somepreferred embodiments, the invention can be characterized as possessingboth the first and second aspects.

In another aspect, the invention provides a method of making a flexibleelectrode suitable for neuromuscular electrical stimulation, comprising:forming an aqueous dispersion of CNTs and a glycosaminoglycan; combiningthe aqueous dispersion with an aqueous emulsion of an elastomer to forma composite precursor; and depositing the precursor onto a surface,removing water, and curing the elastomer to form the electrode. Themethod may further comprise treating the electrode with aqueous sodiumchloride.

In another aspect, the invention provides an electrode, comprising:coalesced polymeric particles, electrical conductor, and ionicconductor; wherein the electrical conductor and ionic conductor aredisposed on the exterior of the coalesced polymeric particles. In somepreferred embodiments, the polymeric particles are elastomeric.

In a further aspect, the invention provides an electrode, comprising:coalesced polymeric particles comprising ionically conductive moietiesthat are bonded to the coalesced polymeric particles, and electricalconductor; wherein the electrical conductor and ionic conductor aredisposed on the exterior of the coalesced polymeric particles.Preferably, the ionically conductive moieties are covalently bonded tothe coalesced polymeric particles.

The electrode of any of the above aspects may be configured in the shapeof a cuff or disposed in an apparatus (such as a sleeve) comprising anarray of the electrodes.

In a further aspect, the invention provides a method of administering amedicine through the skin, comprising: applying any of the electrodesdescribed herein onto the skin of an animal; wherein the electrodecomprises a medicine; and applying a potential across the electrode.

In another aspect, the invention provides a method of conductingneuromuscular electrical stimulation (NMES), comprising: applying theelectrode of any of the previous claims onto the skin of an animal; andgenerating a current through the electrode to activate a muscle.

In some preferred embodiments, the invention can be furthercharacterized by any one or any combination of the following: theelectrode comprising 0.1 to 2 wt % CNTs, preferably 0.2 to 1 wt %, insome embodiments 0.5 to 0.8 wt % CNTs; the electrode comprising 0.1 to 5wt % glycosaminoglycan, preferably 0.4 to 4 wt %, in some embodiments0.7 to 3 wt % glycosaminoglycan; the electrode comprising 10 to 60 wt %water, preferably 20 to 50 wt %, in some embodiments 30 to 50 wt %water; the electrode comprising a mass ratio of glycosaminoglycan to CNTin the range of 0.5 to 5, preferably 1 to 3, and in some embodiments 1.5to 2.5; the electrode comprising at least 0.01 wt % Na, or 0.01 to 2 wt% Na, in some embodiments 0.1 to 1 wt % Na; wherein the electrode has athickness and two major surfaces; and wherein at least 30 wt % of theCNTs are disposed on a major surface or within the 10% of the thicknessnear a major surface; wherein the electrode possesses a conductivity of1000 mS/cm to about 3000 mS/cm that changes by less than 10% after 5strain cycles of extending the material by 50% and allowing the materialto contract; wherein the electrode possesses a ratio of partialconductivity of a charge carrier to the total conductivity, transferencenumber, t_(i) of at least 0.10, preferably at least 0.13, in someembodiments in the range of 0.10 to about 0.20 or 0.15 to about 0.20.

In some preferred embodiments the electrode comprises one or more of thefollowing: wherein the electrode has a top and bottom surface, whereinthe bottom surface is adapted to contact the skin of a patient, whereinthe electrode has a graded structure with an increasing ratio of ionicconductor to electrical conductor from the top to the bottom of theelectrode; wherein the gradient is prepared by layer-by-layerfabrication of the electrode, with increasing levels of ionic conductorin successive layers; preferably having at least 3 layers or at least 5layers; wherein the elastomeric particles comprise nitrile butadienerubber, natural rubber, silicone, Kraton-type, silicone acrylic,polyvinylidene fluoride, polyvinylidene chloride, or polyurethane, orcombinations thereof; wherein, in the emulsion prior to curing, at least90 mass % of the polymer particles are in the size range of 50 nm to 10μm in diameter; wherein the electrical conductors have a number averageaspect ratio of height to the smallest width dimension of at least 10;wherein the electrical conductor comprises carbon nanotubes, graphene,graphite structures, and metal nanowires, and combinations thereof;wherein the ionic conductor comprises hyaluronic acid, fluorosulfonicacids like Nafion™, sulfated polysaccharides and other mucoadhesive typecompounds, or other phosphonic polyvinylsulfonic acids, and combinationsthereof; wherein the polymeric or elastomeric polymer comprises anadhesive polymer or wherein the electrode further comprises an adhesivepolymer; and wherein the coalesced polymeric particles comprise afluoropolymer.

GLOSSARY OF TERMS

The term “carbon nanotube” or “CNT” includes single, double andmultiwall carbon nanotubes and, unless further specified, also includesbundles and other morphologies. The invention is not limited to specifictypes of CNTs. The CNTs can be any combination of these materials, forexample, a CNT composition may include a mixture of single and multiwallCNTs, or it may consist essentially of DWNT and/or MWNT, or it mayconsist essentially of SWNT, etc. CNTs have an aspect ratio (length todiameter) of at least 50, preferably at least 100, and typically morethan 1000. In some embodiments, a CNT network layer is continuous over asubstrate; in some other embodiments, it is formed of rows of CNTnetworks separated by rows of polymer (such as CNTs deposited in agrooved polymer substrate). The CNTs may be made by methods known in theart such as arc discharge, CVD, laser ablation, or HiPco. The G/D ratioof CNTs is a well-known method for characterizing the quality of CNTs.

CNTs are attractive as electrodes because of their high charge storagecapacity due to the high ratio between electrochemical surface area andgeometric surface area (>600 m2/g) characteristic for the nanotubegeometry, which gives rise to a large double-layer charge capacity.

The optical absorbance spectrum of CNTs is characterized by S22 and S11transitions, whose positions depend upon the structure distribution ofthe CNTs and can be determined by a Kataura plot. These two absorptionbands are associated with electron transitions between pairs of van Hovesingularities in semiconducting CNTs.

Carbon nanotubes can be defined by purity factors that includepercentage of metallic impurities (usually catalytic residues such asFe, Mo, Co, Mn, etc,) and percentage of non-carbon nanotube impurities,which can be characterized by methods known in the art such asthermogravimetic analysis. The chemistry of the impurities can bedetermined by methods such as SEM-EDS, and x-ray diffraction (XRD). Itis preferable to use carbon materials that have high purity, as theseoften have better combination of high conductivity and corrosionstability. Less than 1 to 2% metallic impurities are preferred. Carbonscontaining lower purity can also be substantially stabilized by thisinvention.

Glycosaminoglycans are long unbranched polysaccharides consisting of arepeating disaccharide unit. The repeating unit (except for keratan)consists of an amino sugar (N-acetylglucosamine orN-acetylgalactosamine) along with a uronic sugar (glucuronic acid oriduronic acid) or galactose. Glycosaminoglycans are highly polar.Anionic glycosaminoglycans are characterized by having at some hydroxylprotons replaced by a counter ion; typically an alkali or alkaline earthelement. Examples of glycosaminoglycans include: β-D-glucuronic acid,2-O-sulfo-β-D-glucuronic acid, α-L-iduronic acid, 2-O-sulfo-α-L-iduronicacid, 3-D-galactose, 6-O-sulfo-β-D-galactose, β-D-N-acetylgalactosamine,β-D-N-acetylgalactosamine-4-O-sulfate,β-D-N-acetylgalactosamine-6-O-sulfate, β-D-N-acetylgalactosamine-4-O,6-O-sulfate, α-D-N-acetylglucosamine, α-D-N-sulfoglucosamine, andα-D-N-sulfoglucosamine-6-O-sulfate. Hyaluronan is a particularlypreferred glycosaminoglycan and representative of its class.

Sodium hyaluronate is the sodium salt of hyaluronic acid (HA). Hyaluronis a viscoelastic, anionic, nonsulfated glycosaminoglycan polymer (shownbelow). It is found naturally in connective, epithelial, and neuraltissues. Its chemical structure and high molecular weight make it a gooddispersing agent and film former. CNT/HA aqueous dispersion and phasediagram has been reported in the literature (Moulton et al. J. Am. Chem.Soc. 2007, 129(30), 9452). These dispersions may be used to createconductive films by casting the solution onto a substrate and allowingit to dry. However, the resulting films exhibit blistering, i.e. loss ofadhesion, upon exposure to moisture or high humidity. In addition, theysuffer from resistance fluctuations that occur as a result of moisturefluctuations, as HA can expand and contract, changing the junctionresistance between CNT-CNT contacts.

Materials such as sodium hyaluronate are natural products. These may beisolated from animal sources or extracted from bacteria.

The invention is often characterized by the term “comprising” whichmeans “including,” and does not exclude additional components. Forexample, the phrase “a dispersion comprising CNTs and an anionicglycosaminoglycan” does not exclude additional components and thedispersion may contain, for example, multiple types ofglycosaminoglycan. In narrower aspects, the term “comprising” may bereplaced by the more restrictive terms “consisting essentially of” or“consisting of.” This is conventional patent terminology.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic showing of the formation of MIEC.

FIG. 2 shows bulk conductivity vs. CNT solid loading.

FIG. 3 shows water uptake at different HA mass ratios.

FIG. 4 shows water uptake at different HA sodium doping levels.

FIG. 5 is a plot of ionic transfer number vs. material modification.

FIG. 6 schematically illustrates an apparatus for iontophoresis.

FIG. 7 illustrates surface resistance as a function of CNT loading forCNTs dispersed in an acrylate copolymer.

FIG. 8 illustrates sheet resistance as a function of CNT loading for aCNT-polyurethane composite.

FIG. 9 illustrates surface resistance as a function of CNT loading forCNTs dispersed in PVDF.

FIG. 10 illustrates the test set-up to for examining the performancewith skin simulant.

FIG. 11 illustrates impedance of CNT composites with three differentpolymeric materials.

FIG. 12 shows impedance of MIEC with different amounts of HA.

FIG. 13 shows impedance of a gradient electrode as compared with anungraded electrode.

DETAILED DESCRIPTION OF THE INVENTION

The mixed-ionic-electronic conductors (MIECs) are an interconnectednetwork of electrical and ionic conductors in an elastomeric matrix thatprovide: (1) high surface area for efficient capacitivecharge-discharge; (2) high ionic conductivity for low interfacialresistance; (3) low ohmic resistance; and (4) excellent flexibility andtoughness.

Electrical and ionic conductors are embedded in a matrix in such a waythat the electrical and ionic elements achieve percolation, i.e., acontinuous interconnected network, at lower loading than would beachieved by simple random mixing. This allows superior electricalperformance to be achieved while retaining good mechanical properties.

The morphology may be controlled by using a polymer latex, in whichpolymer particles are dispersed in an aqueous phase, to template theorganization of the electrical and ionic conductors, as shown in FIG. 1.Examples of suitable dispersions include elastomeric polymers such asnitrile butadiene rubber, natural rubber, silicone, Kraton-type,silicone acrylic, or polyurethane. Other suitable polymer latticesinclude polyvinylidene fluoride or polyvinylidene chloride. In such adispersion, at least 90 mass % of the polymer particles are preferablyin the range of 50 nm to 10 μm in diameter. The dispersion is cast andthe volatiles (e.g., water) allowed to evaporate. During evaporation,the polymer particles coalesce to form a continuous fill. This processis the common one for creating nitrile gloves.

The electrical and ionic conductors are added to the latex so that theyare dispersed in the aqueous phase. Methods known in the art forbalancing the pH and selecting any necessary dispersing agents can beused. Suitable electrical conductors are those that have high aspectratio and are readily dispersed into aqueous solutions and includecarbon nanotubes, graphene and graphite structures, and metal nanowires.Suitable ionic conductors include sodium hyaluronate, also calledhyaluronic acid, fluorosulfonic acids like Nafion™, sulfatedpolysaccharides and other mucoadhesive type compounds, or otherphosphonic polyvinylsulfonic acids. Likewise, anisotropic ionicconductive particles like graphene oxide and modified graphene oxide maybe used. In some embodiments, HA is preferred due to its tendency tohydrate with the skin, improving the skin contact.

By adding an electrical and ionic conductors to the dispersed phase ofthe latex, the conductors tend to coat the surface of the polymerparticles, but not penetrate. As the latex is dried, the conductors tendto be confined at the interfaces, creating an interconnecting network,where the major phase is elastomeric and a connected thin, layer phaseis the electronic/ionic conductors.

The morphology of this network can be modified by changing the particlesize of the polymer in the latex. Larger particle sizes require lessconductor to reach an interconnected phase. The film formationtemperature is also a tunable parameter that can used to modify thekinetics to achieve various kinetically trapped states. Other methods toachieve better than random mixing include self-assembling orself-stratifying coatings.

In preferred embodiments, carbon nanotubes are the electrical conductorsand hyaluronic acid (HA), or other glycosaminoglycan, along withmoisture and ions, is the ionic conductor. Preferably, the MIECs havehigh conductivity of at least 1000 mS/cm, preferably at least 2000mS/cm, or in the range of 2000 mS/cm to about 4000 mS/cm is desirable.In some preferred embodiments, the MIECs have high moisture retentionsuch that the composite may absorb at least 20% water, up to 50% by masswater (corresponding to 100% of the weight of the dry composite), insome embodiments 20% to 50%, or 35% to 50% water.

In some embodiments, the ionic element is organized into a gradientstructure, getting progressively richer as the material gets closer tothe skin. The electrode performance is improved by introducing a smoothtransition from electronic conduction interface (from the currentcollector/Electrode interface) to ionic conduction interface (from theskin-to-electrode-interface). A gradient can be prepared bylayer-by-layer fabrication of the electrode, with increasing levels ofionic conductor in successive layers.

The invention could also involve combining two functionalities into onepolymer, for example, an elastomer with ionic conductivity. This can beachieved, for example, with grafting of ionic segments from the polymerbackbone. The ionic segments can be anionic, cationic or amphoteric. Onemethod of grafting ionic segment is via co-polymerizing ion-containingmonomers with non-ion-containing monomers. Another way of grafting ionicsegment is via post functionalizing the elastomeric polymer.

Examples of anionic segments include, but not limited to, sulfonic,carboxylic, phosphonic and combinations thereof. Examples of cationicsegments includes alkyl ammonium derivatives such as the N,N-dimethylamino ethyl functionality. Examples of amphoteric segments includes thecombination of anionic and cationic segments.

Examples of grafting anionic segments include, but are not limited to,co-polymerizing anion containing monomer such as styrene sulfonic acidwith non-ion containing monomers such as styrene and butadiene toproduce anion containing styrene-butadiene elastomer, namely sulfonatedstyrene-butadiene elastomer.

Examples of grafting cationic segments include, but are not limited to,co-polymerizing cation containing monomer such as N,N-dimethylaminoethyl methacrylate with non-ion containing monomers such as styreneand butadiene to produce cation containing styrene-butadiene elastomer,namely aminated styrene-butadiene elastomer.

Examples of grafting amphoteric segments include, but are not limitedto, co-polymerizing anion and cation containing monomer such as styrenesulfonic acid and N,N-dimethyl aminoethyl methacrylate with non-ioncontaining monomers such as styrene and butadiene to produce amphotericion containing styrene-butadiene elastomer, namely sulfonated andaminated styrene-butadiene elastomer.

Examples of post functionalizing the elastomeric polymer include, butare not limited to, treating styrene butadiene elastomer with fumingsulfuric acid to produce anion-containing styrene-butadiene elastomer,namely sulfonated styrene-butadiene elastomer.

Ion-containing monomers can be introduced into nitrile elastomers,polyurethane elastomers, silicone elastomers, poly aryl etherelastomers, polyphasphazene elastomers, acrylate elastomers, poly vinylether elastomers, perfluorinated polymeric elastomers, and the like.

The invention includes methods of making electrodes according to thedescriptions provided herein.

The present invention is useful for making elastomers, preferably ascuffs or individually deposited electrodes. It is also useful for makingelectrodes with adhesive properties. The polymer matrix may include anadhesive-type polymer for skin adhesion.

Treatment Methods

The inventive electrode composition can be used in neuromuscularelectrical stimulation (NMES) and iontophoretic drug delivery. Iniontophoresis, an HA dressing matrix is powered by an assembly asillustrated in FIG. 6.

Method of Making/Examples

CNTs are commercially available and a dispersion can be formed by mixingwith an aqueous solution of HA, and optionally with ultrasound. TheCNT/HA dispersion is combined with an elastomer dispersion. In theexamples, the dispersion was a commercial nitrile-butadiene dispersioncommonly used for manufacturing nitrile gloves. The resultingdispersions can be tape cast into a robust, flexible, freestandingcomposite film, which can then be peeled off and cut into desired sizeand shape for an electrode.

The process used to create these composites allows a very low loading ofCNTs to be used and still reach saturation conductivities. The processstarts with an elastomeric dispersion. For the examples in thisdisclosure, Zeon LX550L nitrile butadiene rubber was used. This materialis a latex of acrylonitrile butadiene copolymer (NBR latex). In such adispersion, the polymer particles are primarily 50 nm to 10 μm indiameter. The dispersion is cast and the volatiles (e.g. water) allowedto evaporate. During evaporation, the polymer particle coalesce to forma continuous film. This process is the common one for creating nitrilegloves.

By adding a CNT/HA dispersion to this latex, the CNT and HA tend to coatthe surface of the polymer particles, but not penetrate into theparticles. The CNT/HA dispersion is prepared by mixing purified CNTs(0.1 to 1 wt %) and HA (0.1 to 5 wt %) in water with the assistance ofsonication. Hyaluronic acid sodium salt was from Streptococcus Equi. andcarbon nanotubes are purified single wall carbon nanotubes obtained fromOCSiAl (<1% metallic impurities).

As the latex is dried, the CNT/HA tends to be confined at theinterfaces, creating an interconnecting network, where the major phaseis elastomeric and a connected thin, layer phase is CNT/HA, or theelectronic/ionic conductors.

The morphology of this network can be modified by changing the particlesize of the polymer in the latex. Larger particle sizes require lessCNT/HA to reach an interconnected phase. The film formation temperatureis also a tunable parameter that can used to modify the kinetics toachieve various kinetically trapped states.

The final films are 85-90% polymer, 0.2 to 2 wt % CNT, and 0.2 to 4 wt %HA.

As a comparative example, CNTs were randomly mixed in a siliconeelastomer using typical compounding methods. The resulting composite hada conductivity that was 20 times less than the corresponding sample madeaccording to the method of this Example.

FIG. 2 shows the bulk conductivity of a flexible electrode as a functionof the CNT loading. Bulk conductivity begins to increase near 0.2 wt %CNTs, associated with achieving a percolating network of CNTs. Thepercolating network allows a conductive pathway for electron carriers.As the loading of the CNTs increases, the conductivity of the electrodeapproaches a plateau. A conductivity of about 3000 mS/cm was obtainedfor an electrode composed of 1% CNTs and 1.2% HA in elastomer. Theelastomer-CNT-HA electrode exhibits robustness to repeated stretchingcycles. The film resistance shows negligible change after repeatedstretching to 50% strain. The ionic conductivity and low interfacialresistance are provided by the HA and any moisture in the electrode.

As a comparative example, CNTs were randomly mixed in a siliconeelastomer using typical compounding methods. The resulting composite hada conductivity that was 20 times less than the corresponding sample madeaccording to the method of Example 1.

FIG. 3 shows the water uptake of flexible electrode as a function oftime in water. The results indicate the affinity for water increaseswith increased HA content. The electrical resistance of the film wasstable for a mass ratio of HA/CNT of about 2; above that value there wasa loss of electrical conductivity, which may be due to expanded CNT-CNTjunctions.

The electrochemical performance of the elastomer-CNT-HA flexibleelectrodes was characterized by electrochemical impedance spectroscopy(EIS). The samples were assembled into a fixture using two identicalionic block electrodes (working and reference). The impedance ismeasured in a frequency domain (from 1 MHz to 1 Hz) by applying a smallelectrical perturbation namely voltage (10 mV) and recording the realand imaginary parts of the complex resistance. The obtained Nyquistplots the frequency dependence of the complex resistance for anelectrode made of 0.11 wt % CNTs and 0.15 wt % HA in elastomer withdifferent ionic (Na⁺) content are shown in FIG. 4. From the plots, itcan be seen that the bulk resistance remains constant with increasingNa⁺ loading. The Randles cell model embedded in FIG. 4 was used to fitthe obtained EIS data. The Randles model includes a bulk resistance, adouble layer capacitance and an ionic interfacial charge transfer. Byintroducing Na⁺ into the elastomer-CNT-HA composite, the flexibleelectrode converts to a more ionic conductive material, resulting in anincrease of ionic charge interfacial transfer resistance.

The total conductivity of the composite material is the sum of partialconductivity of charge carrier expressed asσ=FΣc _(i) |z _(i) |u _(i)Where F, c, z, and u are Faraday constant, concentration, charge numberand mobility, respectively. The ratio of partial conductivity of acharge carrier to the total conductivity is defined as transferencenumber of this charge carrier as

$t_{i} = \frac{\sigma_{i}}{\sigma_{tot}}$According to the electrochemical impedance spectroscopy (EIS)measurement shown in FIG. 4, one can calculate the ionic transferencenumber as a function of doping amount (sodium ion) in compositematerial. As shown Table 1, the ionic transference number increased byincreasing the doping level.

TABLE 1 Doping level (as NaCl %) t_(Na+) 0 0.07 0.01 0.13 0.1 0.17 10.19The incorporation of 0.1 wt % to 1 wt % sodium made no significantdifference on the ionic transference number. At 1 wt % NaCl, the ionicconductivity is approaching 20% of total conductivity which is higherthan the pure metallic material.

As shown in FIG. 5, the extent of the ionic conductivity, ionictransference number, in overall electrical performance of the film caneasily be tuned by simply varying the Na⁺ content in HA component of thecomposite material. Increasing ionic transference number above 20% canbe achieved by increasing the mass ratio of HA/CNT above about 3.

Tensile testing was carried out by creating tensile test samples andtesting on Instron. These materials had constant loading of HA butincreasing CNT. As shown in Table 2, the modulus and strength increasedby the addition of CNTs. The addition of 0.2 wt % to 0.5 wt % made nodifference on the elongation. At 1 wt % CNT, the elongation was slightlydecreased but still high.

TABLE 2 0% 0.2% 0.5% 1% CNTs CNTs CNTs CNTs Modulus at 300% (MPa) 0.4010.697 1.052 1.528 Modulus at 500% (MPa) 0.406 0.704 1.029 1.520 TensileStress at 0.654 0.821 1.164 1.722 Max Load (MPa) Maximum Extension 18051806 1806 1491 Stress at Max Extension 0.633 0.814 1.019 1.269Self-Adhesive Conductive Electrode

A self-adhesive acrylate copolymer water based emulsified is identifiedby trade name Pro-Aides, and Ghost Bond™. In a suitably sized vesselequipped with a suitable overhead mechanical stirrer (IKA overhead ModelRW-20 manufactured by IKA-WERK, Germany), the water and acrylatecopolymer emulsion are added at room temperature and mixed. Stirring isslowly increased until a vortex forms in the aqueous solution. The CNTsdispersed in HA aqueous solution, is slowly added to the vortex andallowed to mix until a uniform in composition is formed. The surfaceresistance obtained using 4-point measurement as a function of CNTsamount is shown in the FIG. 7.

Other polymeric matrix capable for producing high performance medicalgrade conductive electrode

Polyurethane (PU)

A CNT aqueous dispersion prepared using ultrasonic treatment was mixedwith as received Polyurethane emulsion in mass ratio indicated in thetable below. A speed mixer such as FlackTek DAC 150 was used tohomogenized CNTs into the polyurethane matrix. The surface resistance asa function of polymer content is shown in FIG. 8. From the figure it canbe concluded that up to 50 wt % based on dry mass, the conductivity issimilar to the conductivity of pure CNTs layer. In addition, thethreshold amount of polyurethane at which the resistance increasesdrastically is about 50 wt %.

Fluoro-Polymers Such as PVDF and Teflon

A CNT aqueous dispersion prepared using ultrasonic treatment was mixedwith an as-received fluoropolymer emulsion (such as PVDF) at differentmass ratios. A speed mixer such as FlackTek DAC 150 was used tohomogenized CNTs into a fluoropolymer matrix. The surface resistance asa function of PVDF is shown in the FIG. 9. Up to 30 wt % PVDF theconductivity of CNTs-PVDf composite material remains almost constant anda drastic increase of surface resistance occurs when the amount of PVDFin the matrix is higher than about 90 wt %.

The performance of different electrodes was tested with a skin simulant,using the set-up shown in FIG. 10. SynDaver synthetic human tissue modelwas used for evaluation of the electrodes. Stainless steel discs wereused as a current collectors. The electrode of interest (MIEC coating)was applied to the stainless steel disk and then contacted with thesynthetic skin. Impedance Spectroscopy testing was performed with twoelectrodes; impedance was measured in the frequency domain from 1 MHz to1 Hz by applying a small perturbation voltage.

The impedance of CNT electrodes prepared using different polymermaterials such as Polyurethane (PU), PVDF and Teflon are shown in FIG.11. As shown in the figure, by incorporation of polymeric material withdifferent toughness and moisture affinity one can tailor the electricalperformance and the interfacial charge transfer.

In preferred embodiments, the t_(i) of the electrode is at least 0.10,preferably at least 0.13, in some embodiments in the range of 0.10 toabout 0.20 or 0.15 to about 0.20. The electrode is doped with at least0.01, or at least 0.10 or up to about 1 wt % sodium; or is doped with atleast 0.01, or at least 0.10 or up to about 1 wt % sodium chloride.

Tensile testing was carried out by creating tensile test samples andtesting on Instron. These materials had constant loading of HA butincreasing CNT. As shown in Table 3, the modulus and strength increasedwith the addition of CNTs. The addition of 0.2 wt % to 0.5 wt % made nodifference on the elongation. At 1 wt % CNT, the elongation was slightlydecreased but still high.

TABLE 3 0% 0.2% 0.5% 1% CNTs CNTs CNTs CNTs Modulus at 300% (MPa) 0.4010.697 1.052 1.528 Modulus at 500% (MPa) 0.406 0.704 1.029 1.520 TensileStress at 0.654 0.821 1.164 1.722 Max Load (MPa) Maximum Extension 18051806 1806 1491 Stress at Max Extension 0.633 0.814 1.019 1.269Some preferred embodiments of the invention can be further characterizedby the above data; for example, a modulus at 300% of least 1 or 0.7 toabout 1.5 MPa; or a tensile stress at maximum load of at least 0.8, orat least 1.1, or 0.8 to about 1.7 MPa; or a maximum extension of atleast 1800 or about 1800; or a stress at maximum extension of at least0.8 or at least 1.0, or 0.8 to about 1.3 MPa; or any combination ofthese characteristics (which may be further combined with any of theother characteristics described herein.Electrode Gradient Design

In some embodiments, the ionic element is organized into a gradientstructure, getting progressively richer as the material gets closer tothe skin. The electrode performance is improved by introducing a smoothtransition from electronic conduction interface (from the currentcollector/Electrode interface) to ionic conduction interface (from theskin-to-electrode-interface). A gradient can be prepared bylayer-by-layer fabrication of the electrode, with increasing levels ofionic conductor in successive layers.

The electrode performance is improved by introducing a smooth transitionfrom electronic conduction interface (current collector/Electrodeinterface) to ionic conduction interface (skin-to-electrode-interface).FIG. 12 shows the Nyquist plot for two different MIEC compositions, withdifferent ratios of HA/CNT. CNT loading was kept constant at 0.4 wt % ofthe electrode and the amount of HA was increased by decreasing theamount of solids from NBR. The interfacial resistance depends on HAloading. When it is too high, the interfacial and bulk conductivitydecreases due to change in CNTs-CNTs connection. The use of a gradientallows better independent tuning of parameters.

The composition of an electrode with a gradient configuration issummarized in the following table 4.

TABLE 4 GRADIENT 1 Component wt % Ratio of HA/CNT Layer ContactingStainless Steel CNT 0.6 2.59 HA 1.6 Solids of Zeon NBR 98 Layer inMiddle CNT 0.85 3.70 HA 3.14 Solids of Zeon NBR 96.01 Layer ContactingSkin CNT 0.27 3.76 HA 1.02 Solids of Zeon NBR 98.71Its impedance, measured in a frequency domain (from 1 MHz to 1 Hz) witha small electrical perturbation namely voltage (10 mV), is compared withan electrode made of 0.4 wt % CNTs and 1.5 wt % HA in elastomer as shownin FIG. 13 (“non-gradient”). As shown in FIG. 13, the incorporation ofgradient structure with 0.2 wt % to 0.8 wt % CNTs significantly improvesthe interfacial charge transfer as indicated by the small semi-circle inthe Nyquist plot at medium and low frequency domain.

The data can be fit to a Randles cell model as discussed above, wherethe interfacial component of interest is described by a parallel circuitwith capacitive (C2) and resistive (R2) elements. The gradient electrodeis better described by two such parallel circuits but for comparison,the system was modeled as a resistor (R1) in series with one interfacialcomponent. The results are shown in Table 5. As shown in Table 5,increasing the amount of HA to CNT in the non-gradient MIEC reduces thecapacitance and increases the interfacial resistance. The gradientprovides a system where these two can be decoupled, both C2 and R2 arelower for Gradient 1 than for MIEC 1.4X.

TABLE 5 CNTs R1 C2 R2 Sample: xHA (%) (Ohm): (nC): (Ohm): MIEC 1.4X 1.40.45 1655 3.427 192.5 MIEC 2.6X 2.6 0.44 1697 2.850 286.3 MIEC 5.0X 5.00.43 1671 2.482 219.1 Gradient 1 2.59, 3.70, 0.62, 0.85, 1627 2.740175.1 3.76 0.27 Gradient 2 1.40, 2.58, 0.62, 0.86, 1791 2.904 198.6 4.780.28Contemplated Example for Making Anionic Styrene Butadiene Elastomer:

In an emulsion reactor charge 51 mL of water, 3.5 grams of SDS and 0.2grams of ascorbic acid. Maintain the temperature of the kettle around 4°C. Add 10 g of styrene 5 grams of SSA and 0.1 gram dodecyl mercaptan.Add of 10 mL of water containing 0.2 grams of potassium persulfate and20 g of butadiene using a mass flow controller to the emulsion kettle atthe same time for about 30 to One hour to produce sulfonated styrenebutadiene elastomer product.

Ingredients

Range Wt (%)

Styrene 5-10

Butadiene 20-40

Styrene Sulfonic acid sodium salt (SSA) 1-5

Sodium dodecyl sulfate (SDS) 2-8

Dodecyl mercaptan 0.01-0.1

Potassium persulfate 0.01-0.2

Ascorbic acid 0.01-0.2

Water—Adjusted to 100 wt %

Contemplated Example for making cationic styrene butadiene elastomer: Inan emulsion reactor charge 51 mL of water, 3.5 grams of CTAB and 0.2grams of ascorbic acid. Maintain the temperature of the kettle around 4°C. Add 10 g of styrene 5 grams of NN-DMEMA and 0.1 gram dodecylmercaptan. Add of 10 mL of water containing 0.2 grams of potassiumpersulfate and 20 g of butadiene using a mass flow controller to theemulsion kettle at the same time for about 30 to One hour to produceaminated styrene butadiene elastomer product.

Ingredients

Range Wt (%)

Styrene 5-10

Butadiene 20-40

N,N′-dimethyl aminoethyl methacrylate (NN-DMEMA) 1-5

Cetyl trimethyl ammonium bromide (CTAB) 2-8

Dodecyl mercaptan 0.01-0.1

Potassium persulfate 0.01-0.2

Ascorbic acid 0.01-0.2

Water—Adjusted to 100 wt %

What is claimed:
 1. An electrode, comprising: coalesced elastomerparticles, carbon nanotubes (CNTs), and a glycosaminoglycan; wherein thecoalesced elastomer particles comprise exteriors; wherein the CNTs andthe glycosaminoglycan are dispersed in a matrix of the coalescedelastomer particles; and wherein the CNTs and the glycosaminoglycan aredisposed on the exteriors of the coalesced elastomer particles; whereinthe electrode has a thickness and two major surfaces; and wherein atleast 30 wt % of the CNTs are disposed on a major surface or within 10%of the thickness near the major surface.
 2. The electrode of claim 1,comprising 0.4 to 4 wt % glycosaminoglycan.
 3. The electrode of claim 1,comprising 10 to 60 wt % water.
 4. The electrode of claim 1, comprisinga mass ratio of the glycosaminoglycan to the CNT in a range of 0.5 to 5.5. An apparatus for treating a patient comprising an array of theelectrodes of claim
 1. 6. An electrode, comprising: coalesced polymericparticles, electrical conductor, and ionic conductor; wherein theelectrical conductor and the ionic conductor are dispersed in a matrixof the coalesced polymeric particles; wherein the coalesced polymericparticles comprise exteriors; wherein the electrical conductor and theionic conductor are disposed on the exteriors of the coalesced polymericparticles; wherein the electrode comprises a top and bottom surface andthe bottom surface is adapted to contact skin of a patient, wherein theelectrode has a graded structure with an increasing ratio of the ionicconductor to the electrical conductor from the top to the bottom of theelectrode.
 7. The electrode of claim 6, wherein the polymeric particlesare elastomeric; and wherein the electrode is made in a process whereinthe electrical and ionic conductors are added to a dispersed phase ofthe coalesced polymeric particles.
 8. The electrode of claim 6, whereinthe graded structure is prepared by layer-by-layer fabrication of theelectrode, with increasing levels of ionic conductor in successivelayers; having at least 3 layers.
 9. The electrode of claim 6, whereinthe electrical conductor comprises particles having a height and asmallest width and wherein the particles have a number average aspectratio of height to the smallest width dimension of at least
 10. 10. Theelectrode of claim 6, wherein the electrical conductor comprises carbonnanotubes, graphene, graphite structures, and metal nanowires, andcombinations thereof.
 11. The electrode of claim 6, wherein the ionicconductor comprises hyaluronic acid, fluorosulfonic acids, sulfatedpolysaccharides and other mucoadhesive type compounds, or otherphosphonic polyvinylsulfonic acids, and combinations thereof.
 12. Theelectrode of claim 6, wherein the electrical conductor comprises carbonnanotubes (CNTs); wherein the electrode has a thickness and wherein atleast 30 wt % of the CNTs are disposed on the bottom surface or withinthe 10% of the thickness near the bottom surface.
 13. An electrode,comprising: coalesced polymeric particles comprising ionicallyconductive moieties that are bonded to the coalesced polymericparticles, and electrical conductor; wherein the coalesced polymericparticles comprise exteriors; wherein the electrical conductor andionically conductive moieties are disposed on the exteriors of thecoalesced polymeric particles; wherein the electrode has a thickness andtwo major surfaces; and wherein at least 30 wt % of the CNTs aredisposed on a major surface or within 10% of the thickness near themajor surface.
 14. The electrode of claim 13, wherein the ionicallyconductive moieties are covalently bonded to the coalesced polymericparticles.
 15. The electrode of claim 13, wherein the coalescedpolymeric particles comprise styrene-butadiene elastomer, nitrileelastomers, polyurethane elastomers, silicone elastomers, poly arylether elastomers, polyphasphazene elastomers, acrylate elastomers, polyvinyl ether elastomers, perfluorinated polymeric elastomers, andcombinations thereof.